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Title: Social competence in children with neurofibromatosis type 1: Relationships with psychopathology and cognitive ability.Background: Neurofibromatosis type 1 (NF1) is a neurodevelopmental disorder associated with elevated risk of specific cognitive impairments and a high prevalence of psychological comorbidities. Children with NF1 have also been reported to display significant difficulties with peer relationships, although the exact nature of their social competence difficulties remains unclear. This study aimed to explore the nature of the day to day social competence difficulties observed in children with NF1 and to investigate how these difficulties might relate to cognitive dysfunction and symptoms of psychopathology.Methods and Findings: This study investigated parent ratings of day to day social competence in 23 children with neurofibromatosis type 1 (NF1) compared to 23 chronological age-matched typically developing controls using a brief, standardised questionnaire -the Social Competence with Peers Questionnaire. The relationships between social competence, psychopathology (parent ratings of Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorder symptomatology), and cognitive ability (Full Scale IQ and parent ratings of functional executive behaviour) in children with NF1 were also explored using correlational analyses. Results indicated that children with NF1 displayed significantly poorer day to day social competence than controls. These social competence deficits were not related to Attention Deficit Hyperactivity Disorder symptomatology, Full Scale IQ or functional executive behaviour. However, difficulties with social competence were significantly related to Autism Spectrum Disorder symptomatology and socially anxious/avoidant behaviours in our NF1 cohort.Conclusions: These results indicate that children with NF1 are at significant risk of day to day social competence difficulties, especially those who display high levels of autistic symptomatology and socially anxious behaviour. Our findings suggest a need to incorporate screening for social competence problems and comorbid psychopathology into the more general clinical management of children with NF1.

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Having access to parenting interventions in the early years is key to improve the developmental outcomes of children with neurodevelopmental problems. The Incredible Years® (IY) Parent Program is a group intervention that has demonstrated efficacy in terms of reducing stress in parents, as well as improving behavioral, emotional, and social outcomes in children. The program has been recently adapted for families of children with autism or language delays (IY-ASLD®). This intervention has not yet been implemented in the Spanish Public Health System, where there is a scarcity of evidence-based interventions being offered to families with young children presenting neurodevelopmental problems. The main aims of this study are to determine the feasibility of implementing the IY-ASLD® program within Spanish Child Mental Health Services and to examine parents’ acceptability and satisfaction with the intervention. As a secondary objective, we aim to evaluate its preliminary effectiveness in terms of reducing parental stress and behavioral difficulties in their children. The FIRST STEPS study is a multicenter, pilot randomized controlled trial comparing the IY-ASLD® program with a treatment-as-usual (TAU) condition. Approximately 70 families of children with autism spectrum disorder (ASD) and preterm children with communication and/or socialization difficulties (aged 2–5 years) will be recruited. Families will be assessed prior to randomization and after the intervention. Due to the COVID-19 pandemic, the intervention will consist of 22 weekly online sessions (approximately 6 months). The FIRST STEPS pilot trial will demonstrate the feasibility and acceptability of reliably implementing the IY-ASLD® program within the Spanish Public Health System. The results of this study could represent the first step to inform policymakers in Spain when designing evidence-based healthcare pathways for families of children presenting ASD symptoms or neurodevelopmental difficulties at early stages. Trial registration ClinicalTrials.gov NCT04358484. Registered on 04 April 2020

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Having access to parenting interventions in the early years is key to improve developmental outcomes of children with neurodevelopmental problems. The Incredible Years® (IY) Parent Program is a group intervention that has demonstrated efficacy in terms of reducing stress in parents, as well as improving behavioral, emotional and social outcomes in children. The program has been recently adapted for families of children with autism or language delays (IY-ASLD®). This intervention has not yet been implemented in the Spanish Public Health System, where there is a scarcity of evidence-based interventions being offered to families with young children presenting neurodevelopmental problems. The main aims of this study are to determine the feasibility of implementing the IY-ASLD® program within Spanish Child Mental Health Services, as well as to examine parents’ acceptability and satisfaction with the intervention. As a secondary objective, we aim to evaluate its preliminary effectiveness in terms of reducing parental stress and behavioral difficulties in their children. The FIRST STEPS study is a multicenter, pilot randomized controlled trial comparing the IY-ASLD® program with a treatment-as-usual (TAU) condition. Approximately 70 families of children with Autism Spectrum Disorder (ASD) and preterm children with communication and/or socialization difficulties (aged 2–5 years) will be recruited. Families will be assessed prior to randomization and after the intervention.The FIRST STEPS pilot trial will demonstrate the feasibility and acceptability of reliably implementing the IY-ASLD® program within the Spanish Public Health System. The results of this study could represent a first step to inform policy makers in Spain when designing evidence-based healthcare pathways for families of children presenting ASD symptoms or neurodevelopmental difficulties at early stages.